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A qualitative study of patient and carer experiences with home respiratory therapies: Long-term oxygen therapy and home mechanical ventilation

Cátia Caneiras, Cristina Jácome, Emília Moreira, Daniela Oliveira, Cláudia Camila Dias, Liliane Mendonça, Sagrario Mayoralas-Alises, João Almeida Fonseca, Salvador Diaz-Lobato, Joan Escarrabill, João Carlos Winck

Thematic Area
Management, Rehabilitation paths, Patients’ perspective
Summary
Studies exploring the experience of patients receiving home respiratory therapies (HRT), such as long-term oxygen therapy (LTOT) and home mechanical ventilation (HMV), are still limited. This study focused on patients’ and carers’ experience with LTOT and HMV. An exploratory, cross-sectional qualitative study, using semi-structured focus groups, was carried out with 18 patients receiving HRT (median 71y, 78% male, 56% on both LTOT and HMV) and 6 carers (median age 67y, 67% female). Three focus groups were conducted in three regions of Portugal. Thematic analysis was performed by two independent researchers. Patients’ and carers’ experience was reflected in seven major topics, linked to specific time points and settings of the treatment: Initial symptoms/circumstances (n = 41), Prescription (n = 232), Implementation (n = 184), Carer involvement (n = 34), Quality of life impact (n = 301), Health care support/navigability (n = 173) and Suggestions (n = 14). Our findings demonstrate a general good perception of the HRT by patients and carers recognizing a significative quality of life impact improvement, while identifying specific points where improvements in healthcare are needed, particularly about navigability issues, articulation between the hospital, primary care and homecare teams, especially regardingprescriptionrenewal. This knowledge is crucial to promote a long-term HRT adherence and to optimize HRT delivery in line with patients’ experience, needs, and values. Moreover, these key points can inform the development of a specific patient-reported experience measure (PREM) for patients on HRT, which is not currently available, and foster a more integrated respiratory care model.
Relevance
The results of this study demonstrate a good general perception of home respiratory therapies by patients and caregivers, recognizing a significant improvement in the impact on quality of life, while identifying specific points where improvements in health care are needed, namely in issues navigability, articulation between the hospital, primary care and home care teams, especially in relation to the renewal of prescriptions. This knowledge is critical to promoting long-term adherence to home respiratory therapies and optimizing the administration of home respiratory therapies taking into account the experience, needs and values of the patients.
DOI
https://doi.org/10.1016/j.pulmoe.2021.05.010
Keywords
Long-term oxygen therapy; Home mechanical ventilation; Focus groups; Patient experience; Quality of care; Chronic care model